ROGELIO SIMON BASA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036046542

License Status

NOT RENEWED

Business

First Name

ROGELIO SIMON

Last Name

BASA

Suffix

Business Name

ROGELIO SIMON BASA MD

Original Issue Date

10/19/1972

Effective Date

10/19/1972

Expiration Date

07/31/1996

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Ever Disciplined

LastModifiedDate

09/20/2006